Provider Demographics
NPI:1851818140
Name:TJOELKER, KIMBERLY (PT, DPT, OCS)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:TJOELKER
Suffix:
Gender:F
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 BARDONIA RD
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-2106
Mailing Address - Country:US
Mailing Address - Phone:845-536-8076
Mailing Address - Fax:866-498-1198
Practice Address - Street 1:201 BARDONIA RD
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-2106
Practice Address - Country:US
Practice Address - Phone:845-536-8076
Practice Address - Fax:866-498-1198
Is Sole Proprietor?:No
Enumeration Date:2017-08-28
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042003-1225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist